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  • Geirsson, ArnarSection of Cardiac Surgery, Yale University School of Medicine, New Haven CT, USA (författare)

Differential outcomes of open and clamp-on distal anastomosis techniques in acute type A aortic dissection

  • Artikel/kapitelEngelska2019

Förlag, utgivningsår, omfång ...

  • Elsevier,2019
  • printrdacarrier

Nummerbeteckningar

  • LIBRIS-ID:oai:DiVA.org:oru-73955
  • https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-73955URI
  • https://doi.org/10.1016/j.jtcvs.2018.09.020DOI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:140702280URI
  • https://gup.ub.gu.se/publication/273264URI

Kompletterande språkuppgifter

  • Språk:engelska
  • Sammanfattning på:engelska

Ingår i deldatabas

Klassifikation

  • Ämneskategori:ref swepub-contenttype
  • Ämneskategori:art swepub-publicationtype

Anmärkningar

  • Funding Agencies:Reykjavik: University of Iceland Research Fund  Reykjavik: Landspitali Research Fund  Stockholm: The Mats Kleberg Foundation 
  • Objectives: Open-distal anastomosis is the preferred technique over clamp-on technique for surgical repair of acute type A aortic dissection (ATAAD). The aim of this study was to define how outcomes of ATAAD were affected by the use of either technique.Methods: Nordic Consortium for Acute Type A Aortic Dissection includes 8 academic cardiothoracic hospitals in 4 Nordic countries. The cohort consisted of 1134 patients, 153 clamp-on and 981 open-distal, from 2005 to 2014.Results: Patients who underwent operation with the clamp-on were younger, more frequently had coronary artery disease, bicuspid aortic valve, hypotension/shock or syncope, and a greater PennClass than open-distal patients. Postoperative cerebral vascular accident occurred less frequently in clamp-on (14/153, 10%) compared with the open-distal group (190/981, 20%). Clamp-on had greater 30-day mortality (39/153, 25%) than the open-distal group (158/981, 16%), and 5-year survival was also worse in clamp-on (61.8% +/- 4.4%) compared with the open-distal group (73.0% +/- 1.6%). The open-distal technique was used more frequently in greater-volume hospitals but was not independently associated with 30-day mortality. Preoperative condition was an independent risk factor whereas hospital volume and later year of operation were beneficial in regard to short-term outcome. Open-distal was independently associated with improved mid-term survival.Conclusions: Patients who underwent operation with the clamp-on were sicker on presentation and had worse short-and mid-term survival compared with the open-distal group. Patients in the open-distal group had greater rates of cerebrovascular complications. The results support the routine use of open-distal anastomosis as the primary operative strategy for ATAAD, although clamp-on can be performed successfully in select cases.

Ämnesord och genrebeteckningar

Biuppslag (personer, institutioner, konferenser, titlar ...)

  • Shioda, KayokoDepartment of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven CT, USA (författare)
  • Olsson, ChristianKarolinska Institutet (författare)
  • Ahlsson, AndersKarolinska Institutet (författare)
  • Gunn, JarmoHeart Center, Turku University Hospital and University of Turku, Turku, Finland (författare)
  • Hansson, Emma C.,1985Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine(Swepub:gu)xhanem (författare)
  • Hjortdal, VibekeDepartment of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Skejby, Denmark (författare)
  • Jeppsson, Anders,1960Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine(Swepub:gu)xjepan (författare)
  • Mennander, AriHeart Center Tampere University Hospital, Tampere, Finland (författare)
  • Wickbom, Anders,1987-Örebro universitet,Institutionen för medicinska vetenskaper,Department of Cardiothoracic and Vascular Surgery(Swepub:oru)aswm (författare)
  • Zindovic, IgorDepartment of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden (författare)
  • Gudbjartsson, TomasLandspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland (författare)
  • Section of Cardiac Surgery, Yale University School of Medicine, New Haven CT, USADepartment of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven CT, USA (creator_code:org_t)

Sammanhörande titlar

  • Ingår i:Journal of Thoracic and Cardiovascular Surgery: Elsevier157:5, s. 1750-17580022-52231097-685X

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